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Assessee
[to be attested on the
photograph]
Assessment Year: 20
-20
10
11
Heads of Income
Amount in Taka
Salaries : u/s 21
Income from house property: u/s 24
Agricultural income: u/s 26
Income from other sources: u/s 33
Total income
Tax leviable on total income
Tax rebate: u/s 44(2)(b)
Tax payable (difference between serial no.6 and 7)
Tax Payments:
(a) Tax deducted or paid in advance/with return Tk...............
(b) Adjustment of Tax Refund (if any)
Tk ..............
Tk..............
Tk. ...........
IT-10BBB
Statement of assets and liabilities for Salaried person (as on ----/----/20
Tk. ...................
2.
Tk. ...................
3.
4.
5.
6.
7.
8.
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Total =
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Total Liabilities
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk. ...................
Tk.....................
Tk.....................
Tk. ...................
Tk.....................
Tk. .....................
Tk. .....................
I solemnly declare that to the best of my knowledge and belief the information given in this form is correct
and complete.
(3) Documents furnished to support the declaration should be signed by the assessee or
his/her authorized representative.
(4) Assets and liabilities of self, spouse (if she/he is not an assessee), minor children and
dependant(s) to be shown in this form.
(5) If needed, please use separate sheet.
(6) Please visit NBRs website www.nbr-bd.org for further information.
..............................................................................................................................................................................
-20
TIN:
Total income shown in Return: Tk ..................................... Tax paid: Tk ...............................
Gross Wealth shown: Tk ...................................... Net Wealth shown : Tk .............................
Date of receipt of return: .............................. Serial No. in Return Register ...............................
Return submitted under section
82BB/ Normal